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General principles that will help you support a smoker

A motivational, non-judgemental style during consultations is more likely to engage patients than a judgemental, directional style.[47][48][49] Playing the role of an interested partner who asks and explores a smoker's determination to quit is likely to be helpful. Motivational interviewing uses empathy rather than confrontation and acknowledges that the patient, not the doctor, is responsible for changing behaviour.

There are four key principles

  1. regard the person's behaviour as their personal choice
  2. let the patient decide how much of a problem they have
  3. avoid argumentation and confrontation
  4. encourage the patient to discuss the advantages and disadvantages of making a quit attempt.[50] (See Motivational tension)

 ASK about smoking status to open up a discussion about quitting smoking

 ASSESS how motivated a smoker is to the idea of quitting and their degree of nicotine dependence

 ADVISE on coping strategies to support the quit attempt

 ASSIST the quit attempt

 ARRANGE follow-up to provide continued support

Q Convey the following recommendations and advice to support a smoker who wants to quit:
  • Recommend total abstinence is essential - not even a single puff
  • Warn that drinking alcohol is strongly associated with relapse
  • Advise your patient to inform friends and family of plans to quit and ask for support; consider writing a 'contract' with a quit date and pinning it on the fridge
  • Recommend removal of cigarettes from home, car and workplace;
  • Advise that withdrawal symptoms occur mostly during the first two weeks and are seldom after 4-7 weeks; relapse after this time usually relate to cues or distressing emotional events. Give practical advice about coping with withdrawal symptoms (See Effects of nicotine withdrawal)
  • Remind patients of the benefits of quitting, especially the immediate or more recent benefits eg within 8 hours carbon monoxide levels drop, sense of smell starts to improve after 2 days; after 4 weeks respiratory cilia start to recover. (See Beneficial effects of stopping smoking)

How to use the Cycle of Change to help smokers quit

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